Provider Demographics
NPI:1649787706
Name:PORTER, CHRISTINA (BCBA/COBA)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:PORTER
Suffix:
Gender:F
Credentials:BCBA/COBA
Other - Prefix:
Other - First Name:CHRISTINA
Other - Middle Name:
Other - Last Name:BRIDGES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BCBA,COBA
Mailing Address - Street 1:130 E WILSON BRIDGE RD STE 200
Mailing Address - Street 2:
Mailing Address - City:WORTHINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43085-2391
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:546 STREAMWATER DR
Practice Address - Street 2:
Practice Address - City:BLACKLICK
Practice Address - State:OH
Practice Address - Zip Code:43004-8135
Practice Address - Country:US
Practice Address - Phone:614-935-7945
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-10
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
OHCOBA.00546103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH010684796Medicaid
OH1473276Medicaid